HomeMy WebLinkAboutJacques (2) +4;k:?-Yz 4
i�, •.. `•. Town Hall, 53095 Main Road
�® * P.O. Box 1179
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0 $' Southold, New York 11971
JUDITH T.TERRY „moi/r.'�=� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 496 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JACQUES, PETER J.
Address 1 : 11655 MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner JACQUES, PETER J.
Mailing Address 1 11655 MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 ROW OFF MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 2 lot 18.002
Cross Street BAYBERRY ROAD
Building Permit Number Cross Reference:
700,14,e4e.
-- 4.-11nrasitreltVorfte.
Issue Date: 5/17/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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TOWN O SOS. ,OL r.�, �v ," P.O. Box 1179
a � 0�h Southold, New York 11971
JUDITH T.TERRY ----. �-- 0' TELEPHONE
TELEPHONE
TO\VN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: MAY 12, 1989
Transmitted herewith is a copy of application No. 507 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter J. Jacques - .
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
•
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
•
APPROVE ,(
DISAPPROVE tn1 n
Comments: �, .I„ti.(4ci-�,� n.^ 1/ 0,zikx � q}-
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Signature
DatedS�/s-J,��
i¢
'"OFFICE U►--THETOWN CLERK C.0f4.0(,i'`,"
Town of Southold , ''. ; �� pp 6 b
Judith T. Terry, Town Clerk E ~ 44,• ,..,•• ° Application No.
Town Hall, 53095 Main Road '3 -l�rr_ t;,•:''
';'-. ,�
P. 0. Box 1179Cri ,`
Southold, New York 11971 0•' Alteration
Telephone ?i ,��O Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /0 ,
DATE -.141Z-1
APPLICANT NAME: PLIC-12 J. J f co.oLS
APPLICANT ADDRESS: //6575' / /1!/'1% f3/ 'V//:1'J RP
5"OuTt-t®L0e N, v, l/q7I
SEPTIC CESSPOOL V
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 5y'5TG/Z4
Fog. 1ii)(. (4 Fi4'l t y /LE$/Dg,-*mac,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: PETER 3. JAC(audJ5
OWNER MAILING ADDRESS: //6 5-5 12 III /319J/0/5u1 /20.
5 VTj-1c &-0, A./. Y, writ
OWNER PROPERTY ADDRESS: O -j ' woo) j 1)YV1EIA-' PP
500'i-101-Pi (.I. y.
TELEPHONE NUMBER OF CONTACT PERSON: 76c — i 0?3
TAX MAP NO. : Section 7g Block p2. Lot I Li
CROSS STREET: L'' ,2m f3A (3j 12R'-? E2
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
9
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Signature of A. licant
RECEIVED BY:
R. ..,,
tnign Clerk's Office
DATE:
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low Cs St otd
I - ' T I SUFFOLK CO HEAL1HDEPT APPROVAL
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